Many studies have indicated that antibiotics are wildly overprescribed for sinusitis (JW Gen Med Jan 31 2012). However, randomized trials on the utility of these medications have had conflicting results, with statistical interpretation complicated by different enrollment criteria and high rates of spontaneous improvement.

In a double-blinded study, researchers randomized 166 adults reporting 1 to 4 weeks of standard sinusitis symptoms (including maxillary pain or tenderness in the face or teeth, and purulent nasal secretions) to receive 10 days of amoxicillin or placebo, along with a range of as-needed symptom-relief medications (acetaminophen, guaifenesin, dextromethorphan, pseudoephedrine, and nasal saline spray). Imaging studies were not performed.

Symptom improvement — evaluated on a standardized questionnaire called the “SNOT-16″ — was indistinguishable between the groups at day 3, slightly favored amoxicillin at day 7, and was then indistinguishable again at day 10. Reported adverse effects of treatment and overall satisfaction with treatment did not differ between groups; recurrence rates were similar.

Comment: These data again support the decision to withhold antibiotics in patients with standard-issue sinus complaints. Unfortunately, clinicians must then do repeated battle with patients who are convinced that only an antibiotic will help them. For these patients, watchful waiting, with the promise of reevaluation should symptoms fail to improve, may be a realistic if not always achievable approach to treatment.

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